Amputation Prevention in Diabetic Patients

Amputation Prevention for Diabetic Patients

BelowKneeAmputationOne of the feared complications of Diabetes is having to undergo a major amputation like a below-knee-amputation (BKA) or above-knee-amputation (AKA) as a result of Diabetic Foot. Patients with diabetes are at higher risk of amputations because of the damaging effects of diabetes on the patient’s nerves and immune (defense system against infection) system. The higher risks of arterial diseases also results in non-healing wounds, potentially leading to tissue death or gangrene.  Amputation has its dangers, with 10% mortality within 30 days, 50% mortality within 2 years and 90% mortality within 5 years.

How to Prevent Amputation without Major Operation?

On a daily basis, diabetic patients should check for new wounds or cuts, keeping the toe web spaces dry. It is important to have good control of diabetes with regular follow up medical checks. Most importantly, diabetic patients should do screenings to make sure that they do not suffer from arterial diseases such as atherosclerosis and the arteries to the foot are not blocked or narrowed. The screening is done by pressured measurements or sonography (vascular ultrasound).

Treatment to Prevent Amputation 

The body requires good blood supply to allow for healing at the area of injury once wounds occur. If the wound gets infected, antibiotics to fight the infection cannot reach the injured area if the blood vessels that carry them there are blocked. In order to overcome this problem, medical procedures need to be done to bring good blood supply to the area of need. In the past, Vascular surgeons perform a by-pass operation to bring blood across the area of blockage. This is a major procedure requiring long hospitalisation stay and involving high risk of stroke or heart attack during the operation.

In the past decade, Vascular Surgeons increasingly are replacing this dangerous procedure with the process of angioplasty. This procedure does not need General Anaesthesia, reducing the operation risks significantly. Patients usually only need to stay overnight for monitoring after the procedure. The procedure involves the introduction of a small device (called the ‘sheath’) into the patient’s groin arteries. Through the sheath, various wires and ballooning devices are passed down to the narrowed areas of the arteries and the area is ‘dilated’ or opened up to improve blood flow. Newer devices like drug coated balloons and drug coated stents help to prolong the period of time for which the arteries remain open and give better results. It is hoped that with this minimally invasive treatment, patients will present early for screening and treatment to prevent unnecessary limb loss and loss of livelihood.

 

Why choose our vascular surgeon, Dr Cheng for Prevention Amputation?

Amputation PreventionIt is important for an experienced surgeon to do the diabetic prevention amputation procedure as a deviation from the correct balloon placement may cause damages. As the Regional Proctor (SEA) of Medtronic Endovascular, Dr Cheng has completed many angioplasty procedures and often invited overseas to supervise or proctor these complex surgeries.  Our doctor is one of the few doctors in Singapore who is able to do stenting for your foot to treat diabetic foot.

Dr Cheng uses the latest technology called drug eluting balloons, that were introduced to Singapore and approved by Health Science Authority in 2010. Dr Cheng is one of the more aggressive surgeons in Singapore using these balloons. The results have been very positive on our patients thus far, with the blockage opening for at least nine to ten months, compared to two to three months in the past. The local data that we have currently mirrors what we have of data sets from Europe– drug coated balloons offer a 70-80 % relative improvement in longevity of patency compared to traditional balloons.

 

 

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